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Montana Program Supports Work Without Causing Harm

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As the Trump Administration continues to encourage states to take Medicaid coverage away from people who don’t meet a work requirement, a new report describes Montana’s promising alternative: a workforce promotion program that targets state resources toward reducing barriers to work. Beneficiary engagement in the program is substantial, the report shows, and participants report high rates of employment and wage increases in the year after completion. Programs like Montana’s can help the small share of Medicaid beneficiaries who can work but aren’t working find and hold jobs, without the harmful and often counterproductive effects of a work requirement.

When Montana expanded Medicaid to more low-income adults under the Affordable Care Act in 2015, policymakers also authorized the state Department of Labor & Industry to administer a workforce promotion program — Montana’s Health and Economic Livelihood Partnership Link (HELP-Link) — for the newly eligible population. HELP-Link targets outreach and services to the minority of Medicaid enrollees who don’t have disabilities or similarly severe barriers to work but who aren’t working, often due to challenges such as limited skills and lack of access to transportation, child care, and other needed work supports. Montana’s approach targets Medicaid enrollees who are looking for work or better jobs, linking them with services such as career counseling, on-the-job training, and subsidized employment.

Since the program’s start in 2016, 95,000 Montanans have enrolled in Medicaid through the expansion, and 25,000 of them have enrolled in workforce training through the Montana Department of Labor and Industry, according to the state. Of those, 62 percent are employed in the quarter after completing the training, and 70 percent are employed within a year. Fifty-eight percent of participants report wage increases in the year after participation, with a median increase of more than $8,000 in annual wages. While the state hasn’t analyzed how many people would have found employment without the training, beneficiary engagement with the program shows its promise.

Montana’s HELP-Link program offers a striking contrast to Arkansas’ policy of taking Medicaid coverage away from people who don’t meet the state’s harsh work requirements. That policy has already taken coverage from more than 12,000 people, almost certainly including working people and people who should be exempt from the new rules but are stymied by complex reporting requirements. And for those who aren’t working, the policy is likely counterproductive. The most common employment barriers identified by Montanans enrolled in HELP-Link include challenges related to personal finances and credit history, a prior conviction, lack of transportation, and poor physical health. Low-income adults who face one or more of these challenges won’t likely overcome them without support — and taking their health coverage away, as Arkansas is doing, likely makes it even harder to find or keep a job. But Montanans’ engagement in workforce training demonstrates their interest in overcoming employment barriers, and the state-provided services may result in higher rates of Medicaid beneficiaries joining the workforce.

Along with providing needed workforce training and support, HELP-Link avoids the complex and costly administrative systems required to implement work requirements. Montana allocated just $885,400 for HELP-Link’s outreach, trainings, and linkages to other services in fiscal year 2018 and $888,500 in 2019. In contrast, Kentucky reported that it planned to spend $187 million in fiscal year 2019 — more than 200 times as much as HELP-Link — to implement its program, which will take coverage away from people who don’t meet a work requirement or pay premiums, as well as impose co-pays and create complex accounts resembling health savings accounts.

By investing in targeted outreach and services, Montana is spending state funds on services that could actually increase employment and income for low-income people. Policymakers from other states should look to HELP-Link as an example, rather than taking coverage away from people with barriers to employment.